Patient Information
SHOULDER JOINT ARTHROSCOPY
Shoulder arthroscopy is a surgery method that enables the diagnosis and treatment of
injuries and diseases of the shoulder joint with the minimum invasion. The surgery is
performed under a general anaesthesia. Similar to an arthroscopy of other joints, the
shoulder arthroscopy also involves the insertion of an endoscopic optical instrument
into the joint via a small cutaneous incision. The camera on the endoscope projects an
enlarged image of the inside of the joint onto a display and thus enables the surgeon to
examine all the anatomical structures inside the joint and in its immediate vicinity.
Due to the high level of technical complexity of the procedure, the shoulder arthroscopy
has only been established in the last decade. At first, the arthroscopic procedures in the
shoulder were limited mainly to diagnostic procedures and simpler procedures such as
the removal of loose fragments, grinding degenerative bone growths and the
interruption of an inflammation-transformed tendon of the long head of the biceps.
With the development of arthroscopic techniques and with the improvement of
instruments and technical equipment, more complex procedures in the shoulder were
made possible, such as the reconstruction of a torn rotator cuff and the reconstruction
of the labrum and joint capsule in the event of a repeat dislocation of the shoulder joint.
With modern surgery techniques and suitable technical equipment and expertise, it is
now possible to treat the majority of injuries and diseases of the shoulder joint
arthroscopically.
INF. 03/10
The Shoulder Joint Arthroscopy Procedure
A shoulder arthroscopy is a surgery procedure performed under general anaesthesia. To
perform a diagnostic arthroscopy of the shoulder, just two cutaneous incisions are
generally required, each 0.5-1 cm in length. Through the first, which is located on the
back side of the shoulder, an optical instrument is inserted and through the second,
located in the front, a sensor is inserted that is used to examine the inside of the joint.
To perform more complex procedures, an additional 1 to 3 cutaneous incisions are
made, each of which is usually no longer than 0.5 cm. These additional approaches are
required to insert instruments and stitches and other surgical implants into the joint.
Similar to a knee arthroscopy, during the procedure, the shoulder joint is filled with
sterile lactated Ringer’s solution. This is a special solution of water and electrolytes that
is used to rinse out the joint, somewhat expand it and thus enable good visibility of the
inside of the joint.
A shoulder arthroscopy is usually performed in two steps. During the first part of the
procedure, an arthroscope is inserted into the glenohumeral joint, namely the main
joint in the shoulder in which the humerus and the joint surface of the shoulder blade
called glenoid are joined. In the event of issues related to the instability of the shoulder
joint, damage to the glenoid labrum (a structure similar to the meniscus that covers the
joint surface of the shoulder blade glenoid), issues related to the tendon of the long
head of biceps or a partial tear of any of the rotator cuff tendons from the inside, these
issues can be discovered by simply examining the inside of the glenohumeral joint.
During this diagnostic examination of the joint, degenerative or injury changes to the
cartilaginous surfaces of the head of the humerus or the shoulder blade glenoid, loose
fragments in the joint, bone defects as a result of repeated dislocation or a complete
tear of any of the tendons of the rotator cuff may be observed. A diagnostic arthroscopy
is then continued by inserting an arthroscope into the subacromial bursa. This is a
structure located between the outside surface of the rotator cuff and the lower surface
of the acromion and in a healthy shoulder ensures the smooth sliding of the tendons of
the rotator cuff under the bone surface of the acromion. By inserting an optical
instrument into the subacromial bursa and by expanding it with the Ringer’s lactate
solution, a space is created that enables a suitable examination of the outside surface of
the rotator cuff and the lower surface of the acromion.
During the shoulder arthroscopy, the planned surgical procedure is carried out
depending on the type of injury or disease. In this way it is possible to treat a tear of the
rotator cuff tendons, issues related to the instability and chronic inflammation of the
tendon of the long head of the biceps, chronic instability of the shoulder joint,
degenerative changes in the section of the acromioclavicular joint, subacromial
narrowing due to excessive curvature of the acromion – and these are only a few of the
most common conditions.
Depending on the extent and complexity of the procedure, the surgery can last from 20
minutes to two hours. After the procedure, the patient spends a short time lying in the
awakening room and is then released into home care on the same day.
INF. 03/10
The Advantages of Invasive Arthroscopic Shoulder Joint Procedures
Arthroscopic surgery methods that enable the treatment of joint injuries or diseases
with minimal invasion have many advantages over classic surgery procedures. In the
shoulder joint, arthroscopy enables a more comprehensive examination of the entire
joint and the display of numerous anatomical structures that are not accessible with
classic surgery procedures. Another great advantage of the arthroscopic procedures on
the shoulder is the fact that they enable the preservation of the deltoid muscle. This is a
main muscle that covers the entire surface of the shoulder joint and provides the main
force for the raising movement of the arm. Preserving this muscle during an
arthroscopic procedures means less pain during the postoperative period, there is no
scarring and adhesion problems that can generally occur between the lower surface of
the deltoid muscle and the tendons of the rotator cuff. This also enables faster recovery.
Arthroscopic surgery procedures on the shoulder also have a significantly lower risk of
postoperative superficial and deep infections of the joint, the risk of excessive bleeding
occurring and damage to nerves running near the shoulder joint is also lower. Last but
not least, because the cutaneous incisions are tiny, the cosmetic effects of the surgery
are also significantly better.
Indications for a shoulder joint arthroscopy
 Chronic subacromial narrowing
 Rotator cuff tear
 Repeated shoulder dislocation
 Chronic shoulder instability
 Bicipital tendinitis





Calcific tendinitis
Injury and arthrosis of the AC joint
Labrum damage
Adhesive capsulitis
Unexplained pain in the shoulder
Rehabilitation after a Shoulder Arthroscopy
Due to the minimal invasiveness, rehabilitation after arthroscopic procedures is faster
and easier in many ways than after classic surgery procedures. After such a surgery,
there is less pain and in some cases the joint function is also restored faster. The actual
time of recovery depends on the type of procedure performed and is relatively short for
simple procedures such as the interruption of an inflammation-transformed tendon of
the long head of the biceps, removing loose fragments or the resection of bone changes
on the lower surface of the acromion. Rehabilitation takes significantly longer after a
more complex reconstruction procedure, such as sewing up torn rotator cuff tendons
and surgery of chronic instability where, besides the performed surgery, a key factor of
the rehabilitation time is also the healing speed of the restructured tissue.
Rehabilitation after such procedures usually lasts 4 to 6 months. If there are
degenerative changes already present in the joint or if tissue that was restructured is
significantly changed by degeneration and has a bad healing potential, this contributes
to a much longer time required for the rehabilitation process and also leads to a less
favourable end result of such a treatment.
Directly after the surgery, the shoulder has to be cooled several times per day with ice,
which decreases the swelling of the joint and also eases the pain. After the patient is
INF. 03/10
released, we prescribe a suitable analgesic therapy and the patient also receives
instructions regarding activities they are allowed to perform with the affected arm.
During the first days after the surgery, resting the arm is generally recommended. After
the pain subsides, the patient can start gradually using the arm for everyday tasks.
Restructuring procedures such as sewing up torn rotator cuff tendons and shoulder
instability surgery are an exception. They require a longer period of rest and slower
rehabilitation. At the check-up after the surgery, an individual programme of physical
therapy is prescribed that is adapted to the individual and the type of procedure
performed.
Risks and Complications Related to Shoulder Arthroscopy
As with all surgical procedures, the shoulder arthroscopy can also lead to complications,
though in the majority of cases these are extremely rare due to the minimum
invasiveness of the procedure. The following risks and complications exist during such
procedures:
 Bacterial contamination of the wound
 Bacterial contamination of the joint
 Bleeding into the joint
 Long-term swelling and pain in the joint
 Breakage of instruments in the joint
 Injury to nerves and blood vessels near the joint
 Blood clots, consequently also emboli (lodging of a blood clot in the blood vessel)
 Wounds on the skin and compression damage to nerves due to pressure against
the operating table
 Allergic reactions to medication
 Failure of the technical equipment used to perform the surgery
 Exceptionally, the above complications can lead to a need for additional surgical
procedures or to convert the arthroscopic procedure into classic surgery.
Preparation before Surgery
A week before the planned surgery, basic lab tests (blood count, electrolytes, PT, INR)
have to be performed at a general practitioner. Patients older than 40 and everyone
with any accompanying chronic diseases additionally need a chest x-ray and an EKG.
Changes to the general health condition can affect the performance of the surgery,
therefore in the event of the following conditions, immediately notify the doctor that
ordered your surgery:




symptoms of cold
increased body temperature
irritation in the eyes, ears, throat, palms or dental issues
lesions, cuts or wounds on skin
INF. 03/10



gastrointestinal diseases with problems such as nausea, vomiting, stomach pain,
diarrhoea, blood in the stool
renal and urinary disorders with problems such as a burning sensation during
urination, kidney cramps, very frequent urination, blood in urine
if there is a possibility you are pregnant.
When arriving for the surgery, you should have all your existing medical documents with
you, including all images, and a signed consent form for performing the proposed
surgery procedure. For minors, the surgery consent should be signed by the parents or
caretakers. Before the surgery, the doctor should be urgently informed about any
possible known allergies or sensitization to medication. For minors, the surgery consent
should be signed by the parents or caretakers. Before the surgery, the doctor must be
informed about all the medication you are regularly taking.
IMPORTANT INSTRUCTIONS BEFORE THE SURGERY:








Consuming food or drink at least 6 hours before the planned surgery is not
allowed.
On the day of the surgery, intensively wash the shoulder and armpit area for at
least 5 minutes with soap during showering.
On the day of the surgery, take all your regular medication, unless you receive
different instructions from the doctor.
Do not attend the surgery wearing make-up, remove any nail polish from your
nails.
Wear comfortable clothes that are easy to take off and put on.
If you have crutches or a brace that you have been using, take them with you.
We ask that you leave all your jewellery, any watch and other valuable objects at
home.
When you leave for home, it is essential that you are accompanied by a person
of legal age, because driving a motor vehicle is not allowed directly after the
surgery. You will be released home on the day of the surgery.
We are available for additional explanation via the phone numbers 00 386 40 799 622
and 00 386 1 518 7063 or via e-mail: info@artros.si
INF. 03/10